ABSTRACT
-
Objective
Although healthy dietary habits established in early childhood are critical for lifelong health, most previous studies have relied predominantly on parental proxy reports rather than children’s self-perceptions. This study compared preschoolers’ self-perceived healthy dietary practices with their parents’ evaluations and examined discrepancies between them.
-
Methods
This study included 243 preschoolers aged 2 to 7 years and their parents, recruited from daycare centers in Cheonan, South Korea. Data were collected using the validated, structured, self-administered Healthy Eating Practice Questionnaire, which assessed nutrition and hygiene. Mean Healthy Eating Practice Scores were compared between preschoolers and their parents using paired t-tests, and stratified analyses were conducted by sex and age.
-
Results
Preschoolers rated their healthy dietary practices significantly higher than their parents did (P<0.001). The discrepancy was greater for nutrition than for hygiene, with hygiene ratings more consistent. This domain-specific pattern was consistent across sexes and age groups. When stratified by sex and age, preschooler-parent Healthy Eating Practice Score differences were significantly higher in boys than in girls (25.0±21.0 vs. 20.0±14.9, respectively; P=0.035).
-
Conclusion
Discrepancies between preschoolers’ self-perceptions and their parents’ evaluations suggest that incorporating both perspectives is essential for accurately assessing children’s dietary practices. These findings support the development of dual-perspective dietary assessment and education strategies in early childhood.
-
Keywords: Preschool; Parents; Eating behavior; Perception
INTRODUCTION
The prevalence of obesity and picky eating habits among children and adolescents in South Korea has steadily increased [
1]. Selective eating and consumption of high-calorie, low-nutrient foods in early childhood increase the risk of nutritional deficiencies during growth and chronic diseases in adulthood, including obesity, diabetes, and cardiovascular diseases [
2,
3]. Early childhood is a critical period for establishing dietary habits [
4], which directly influence future food choices, nutritional balance, and self-regulatory skills [
5]. Therefore, establishing proper dietary habits in early childhood is essential for lifelong health, highlighting the need for early nutritional education and guidance.
However, rising dual-income families and dining-out culture have reduced home mealtimes, making preschoolers’ dietary management increasing challenging. Particularly, children’s dietary habits are not merely personal preference but are directly influenced by parental eating attitudes and guidance behaviors [
6-
8]. As key role models, parents’ nutritional knowledge, eating habits, and attitudes are closely associated with their children’s healthy dietary practices [
7-
10].
To promote healthy dietary habits in preschoolers, it is essential to understand the process of changes in their dietary behaviors. However, most previous studies, both domestic and international, have relied on parent or teacher reports rather than children’s self-perceptions [
11-
13]. Previous studies have demonstrated meaningful parent-child differences in reports of identical health-related behaviors [
14], with studies on dietary habits showing that parents tend to overestimate the quality of their children’s actual behaviors [
15].
These findings highlight the limitation of relying solely on parental perceptions, which may not fully capture preschoolers’ perspectives on dietary behavior changes or accurately identify their health behaviors or dietary problems. Furthermore, analyzing parent-child perceptual gaps is significant for identifying their determinants and understanding children’s perceptions of healthy eating behaviors. However, studies directly comparing infants’ self-awareness with parents’ perceptions remain limited [
16]. To better understand behaviors related to the development of healthy dietary habits in preschoolers, research that incorporates both children’s direct responses and parental assessments is essential. Therefore, this study aimed to examine discrepancies between preschoolers’ self-perceived healthy dietary attitudes and practices and their parents’ evaluations.
METHODS
Ethics statement
This study was approved by the Institutional Review Board of Dankook University (No. 2024-05-050-007) and adhered to the Declaration of Helsinki principles. The study procedures were explained in detail to all participants before the study began, and informed consent was obtained.
Study design
This cross-sectional survey compared preschoolers’ self-perceived levels of healthy eating practices with their parents’ evaluations of the children’s practices. In addition, the study examined whether discrepancies between children’s and parents’ perceptions varied by child’s sex and age.
Study participants
The study participants were preschoolers aged 2 to 7 years and their parents, recruited from daycare centers and kindergartens supported by the Center for Children’s Foodservice Management (CCFSM) in Cheonan, South Korea. The survey was conducted in two phases: the first phase from August to November 2024, and the second phase from April to May 2025.
In the first phase, 136 pairs of preschoolers and parents participated; however, six pairs were excluded for incomplete responses, resulting in a final sample of 130 pairs (n=260) included in the analysis. In the second phase, 118 pairs participated, and after excluding five pairs with insufficient data, 113 pairs (n=226) were included. Finally, a total of 243 pairs (n=486) from both phases were pooled for the final analysis.
General characteristics and growth status assessment of preschoolers
General characteristics of the preschoolers, including sex, age, height, weight, and body mass index (BMI), were obtained through self-reported questionnaires completed by their parents at the time of the survey. To assess growth status, we used the 2017 Korean National Growth Charts for Children and Adolescents developed by the Korea Disease Control and Prevention Agency and the Korean Pediatric Society. Short stature was defined as height-for-age below the 3rd percentile, and underweight as weight-for-age below the 5th percentile. Based on BMI-for-age percentiles, children were classified as underweight (<5th percentile), normal weight (5th to <85th percentile), overweight (85th to <95th percentile), or obese (≥95th percentile) [
17].
This study used the HEPQ developed to target infants and young children aged ≥24 months and validated through a stepwise process from 2020 to 2022 to objectively assess the level of healthy dietary practices in preschoolers, including the effectiveness of early childhood education programs at the CCFSM [
16,
18]. The HEPQ was designed using child-friendly facial expressions and illustrations so that children can independently choose response options to questions and consisted of versions for both preschoolers and parents, with established reliability and validity. Core dietary items were derived and subjected to rigorous validation during initial development [
16,
18]. Subsequently, the scoring system and domain-specific criteria were established, with evaluation objectivity strengthened through correlation analysis with the Nutrition Quotient for Preschoolers [
18].
The HEPQ assesses dietary behaviors, including food preferences, intake levels, and hygiene practices (hand washing and tooth brushing), categorized into two domains: nutrition and hygiene. The questionnaire responses from both preschoolers and parents were evaluated across four subdomains: food preference, food intake level, hand washing, and tooth brushing. Based on questionnaire responses, the Healthy Eating Practice Score (HEPS) was calculated. Each subdomain comprises three to five items, and the responses, measured on 3- to 5-point Likert scales, were converted to a 100-point scale for standardized scoring.
Statistical analysis
Categorical variables describing the general characteristics of preschoolers were summarized as frequencies and percentages (%). Continuous variables, such as age, height, and weight, were expressed as mean±standard deviation. The HEPS scores for preschoolers and parents were calculated as mean±standard deviation. Differences between child- and parent-reported HEPS scores were analyzed using paired t-tests. Independent t-tests were used to examine whether discrepancy scores differed by child’s sex or age group. All statistical analyses were performed using IBM SPSS ver. 28.0 (IBM Corp.), and statistical significance was defined at P<0.05.
RESULTS
General characteristics of preschoolers
General characteristics of the participants are presented in
Table 1. Among the 243 children, 117 (48.1%) were boys and 126 (51.9%) were girls. Three-year-olds comprised the largest age group (n=64, 26.3%), followed by 4-year-olds (n=61, 25.1%) and 5-year-olds (n=51, 21.0%). Most children were within the normal range for height (n=229, 94.2%) and weight (n=225, 92.6%). For BMI, 184 children (75.7%) fell within the normal range, followed by the overweight or obese group (n=44, 18.1%) (
Table 1).
The difference between preschoolers’ self-reported HEPS scores and parental HEPS scores is shown in
Table 2. The total scores reported by preschoolers were significantly higher by 22.4 points than the scores evaluated by parents (P<0.001). Regarding the subdomains, preschoolers’ self-reported scores for food preference (mean=78.2) and food intake level (mean=85.3) were significantly higher than parental evaluations (73.4 and 66.9, respectively; P<0.001). Conversely, for the hygiene subdomains (hand washing and tooth brushing), parental evaluation scores were slightly higher than those of the children; particularly, in tooth brushing, parents (mean=42.2) scored significantly higher than preschoolers (mean=41.6) (P=0.033).
When stratified analyses to compare the HEPS total scores reported by preschoolers and their parents were conducted by sex and age, preschoolers’ self-reported scores were significantly higher than those reported by parents, regardless of sex and age (P<0.001). However, results varied across subdomains. In both boys and girls, and in both age groups (≤4 and >4 years), preschoolers’ self-reported scores were significantly higher than parents’ scores in the food preference and intake levels subdomain (P<0.001). Conversely, in the hand washing or tooth brushing subdomain, parents’ scores tended to be higher than preschoolers’ self-reported scores, although this difference was not statistically significant (
Table 3).
Analysis of preschooler-parent score differences by sex and age showed significant differences by sex only. The mean difference in total HEPS scores was significantly higher for boys (25.0 points) than for girls (20.0 points, P=0.035). In terms of the subdomains, boys showed a significantly larger discrepancy in the food preference domain (6.0 points) compared to girls (3.7 points, P=0.017). Conversely, no significant sex differences were observed in food intake level, hand washing, or tooth brushing (P>0.05) (
Table 4).
DISCUSSION
Although parental reports have traditionally been the primary method for assessing children’s dietary behaviors, relying solely on them may overlook the significant perceptual differences between parents and children. This study addressed this gap by directly comparing preschoolers’ self-perceptions with parental evaluations, thereby providing a more comprehensive basis for pediatric dietary guidance. Overall, preschoolers rated their own dietary practices significantly more positively than their parents, with the largest discrepancy observed in food preferences.
These findings are consistent with previous studies reporting parent-child discrepancies in health behavior perceptions. For example, Lago-Ballesteros et al. [
19] found significant differences between adolescents’ actual physical activity levels and those perceived by adolescents and their parents, highlighting perceptual gaps in health-related behaviors within families. Although their study focused on physical activity among adolescents rather than dietary habits in preschoolers, it supports the consistency of parent-child perceptual discrepancies across health domains.
These perceptual discrepancies may reflect developmental characteristics of early childhood. Egocentric thinking and positive illusions often lead preschoolers to overestimate their own abilities, contributing to differences between parental and child responses. Supporting this, Venkatesh and DeJesus [
20] reported that preschoolers’ self-reports on eating behaviors more positively than those of their parents. Similarly, Warren et al. [
21] suggested that such overestimation may result from inherent cognitive and reporting limitations in young children. In this study, parent-child discrepancies in HEPS remained highly significant among older preschoolers (>4 years; paired t-test, P<0.001), in whom self-reporting is developmentally more reliable, with a magnitude comparable to that in younger children (≤4 years). This indicates that the observed discrepancy is robust across cognitive developmental phases and is not an artifact of the youngest children’s self-reports.
The analysis of perceptual discrepancies by sex showed that parent-child score discrepancies were significantly larger for boys than for girls. This result aligns with the findings of Wrottesley et al. [
22], who reported that perceptual differences between children and parents are structurally distinct by sex. This finding may reflect boys’ higher activity levels and impulsive tendencies, which may lead to more positive perceptions of their eating habits. Alternatively, it may reflect that parents monitor boys’ dietary behaviors more strictly than girls’.
Parents’ tendency to evaluate their children’s behaviors more negatively than children themselves may reflect higher parental expectations, as Liu et al. [
23] and Berge et al. [
24] reported that parents with higher health expectations and normative standards tend to assess behaviors more strictly than they are in reality. This aligns with studies by Kwon et al. [
25] and Marwaha et al. [
26], which frequently observed instances in which parental evaluations did not align with children’s actual behaviors or self-perceptions. Specifically, parents may apply more conservative criteria due to concerns about picky eating and inadequate intake, whereas preschoolers interpret their behaviors positively, thereby contributing to significant perceptual gaps.
These findings reveal that close cooperation between families and educational institutions is essential for improving healthy eating practices among preschoolers. Although positive self-perception may motivate children, discrepancies between perception and actual behavior may hinder the development of healthy eating habits. Therefore, parents and educators should understand preschoolers’ developmental characteristics and provide age-appropriate guidance. Parent education programs that promote objective assessment of their children’s dietary development may help reduce the perceptual gap between children and parents through dietary education linked with home-based activities.
Limitations
This study has several limitations. First, the regional sample of preschoolers and parents may limit the generalizability of the findings to the broader population. Second, self-administered questionnaires may have introduced social desirability bias and recall error. Third, the food intake level subdomain was assessed based on perceptions rather than actual dietary intake, thereby limiting quantitative dietary assessment. The largest parent-child discrepancy was observed in this domain, with children rating their intake substantially higher than their parents did. On the parental side, picky or fussy eating is common among preschoolers and a frequent source of parental concern [
24,
25]. Parents worried about their child’s eating may focus on food refusal and inadequate intake, leading to conservative proxy ratings that reflect feeding concern rather than actual consumption. On the child’s side, preschoolers may overestimate their dietary behaviors due to self-presentation and developmental optimism bias, with a tendency to report eating foods and recall preferred or recent meals more readily. These findings indicate that perception-based food intake ratings are subject to systematic biases among reporters, highlighting the need to complement them with objective dietary assessments and to address parental feeding concerns in preschool nutritional interventions. Fourth, this descriptive study did not examine factors potentially associated with the magnitude of parent-child perception discrepancies. These discrepancies may be influenced by a child’s weight status (e.g., overweight or obesity), parental feeding attitudes, and the dietary environment. Future studies investigating the relationship between perception discrepancies and clinical growth indicators are warranted. Despite these limitations, this study is among the first to directly compare preschoolers’ self-reported dietary perceptions with parental evaluations in a Korean population, providing foundational evidence for dual-perspective approaches in early childhood nutrition assessment. Future studies should include diverse regions and socioeconomic backgrounds to improve the generalizability of the findings. Additionally, future research incorporating observation-based behavioral assessments and objective dietary measures, such as the 24-hour recall method, is needed to determine how parent-child perceptual discrepancies relate to actual nutritional status.
This study found that preschoolers consistently rated their dietary practices more positively than their parents did, regardless of sex and age, with the largest discrepancies observed in food preferences and intake rather than hygiene-related behaviors. Notably, the perceptual gap was significantly larger in boys than in girls, suggesting sex-specific influences on parent-child discrepancies. These findings highlight the need to incorporate both child and parental perspectives in early childhood dietary assessment. Tailored dietary education programs that address these perceptual gaps may provide practical and policy-relevant evidence for promoting healthy eating habits.
NOTES
-
Author Contributions
Conceptualization: KK. Methodology: JA, SL. Validation: KK. Formal analysis: JA. Investigation: all authors. Data curation: all authors. Supervision: KK. Writing - original draft: JA, SL. Writing - review & editing: SL, KK. All authors read and approved the final manuscript.
-
Conflict of Interest
None.
-
Funding
None.
-
Data availability
The data in this study are available from the corresponding author upon reasonable request.
Table 1.General characteristics of study participants
Table 1.
|
Variable |
Total |
|
Sex |
|
|
Boy |
117 (48.1) |
|
Girl |
126 (51.9) |
|
Total |
243 (100) |
|
Age (yr) |
4.19±1.23 |
|
2 |
46 (18.9) |
|
3 |
64 (26.3) |
|
4 |
61 (25.1) |
|
5 |
51 (21.0) |
|
6 |
19 (7.8) |
|
≥7 |
2 (0.9) |
|
Total |
243 (100) |
|
Height (cm) |
102.88±9.62 |
|
Normal |
229 (94.2) |
|
Short staturea)
|
14 (5.8) |
|
Total |
243 (100) |
|
Weight (kg) |
17.65±8.06 |
|
Normal |
225 (92.6) |
|
Underweightb)
|
18 (7.4) |
|
Total |
243 (100) |
|
Body mass indexc)
|
|
|
Normal |
184 (75.7) |
|
Underweight |
15 (6.2) |
|
Overweight or obese |
44 (18.1) |
|
Total |
243 (100) |
Table 2.HEPS difference scores between preschoolers’ self-perceptions and parental perceptions
Table 2.
|
HEPS |
Preschooler |
Parent |
Difference |
P-valuea)
|
P-valueb)
|
|
Total |
248.5±22.9 |
226.1±24.7 |
22.4±18.2 |
˂0.001 |
˂0.001 |
|
Food preference |
78.2±9.9 |
73.4±10.1 |
4.8±7.6 |
˂0.001 |
˂0.001 |
|
Food intake level |
85.3±12.4 |
66.9±13.2 |
18.4±12.4 |
˂0.001 |
˂0.001 |
|
Hand washing |
43.5±5.4 |
43.7±4.5 |
−0.2±4.0 |
0.673 |
0.465 |
|
Tooth brushing |
41.6±6.3 |
42.2±5.8 |
−0.7±4.7 |
0.238 |
0.033 |
Table 3.Comparison of HEPS scores between preschoolers’ self-perceptions and parental perceptions stratified by sex and age
Table 3.
|
Variable |
Preschooler |
Parent |
Difference |
P-valuea)
|
P-valueb)
|
|
Sex |
|
Boy |
|
HEPS |
248.8±21.3 |
223.3±24.6 |
25.0±21.0 |
˂0.001 |
˂0.001 |
|
Food preference |
78.9±9.0 |
72.9±8.9 |
6.0±7.8 |
˂0.001 |
˂0.001 |
|
Food intake level |
85.8±12.2 |
65.9±12.9 |
19.7±13.9 |
˂0.001 |
˂0.001 |
|
Hand washing |
43.2±5.9 |
43.1±4.8 |
0.1±4.7 |
0.797 |
0.846 |
|
Tooth brushing |
40.9±6.5 |
41.5±6.1 |
−0.8±5.3 |
0.421 |
0.089 |
|
Girl |
|
HEPS |
248.2±24.4 |
228.2±25.0 |
20.0±14.9 |
˂0.001 |
˂0.001 |
|
Food preference |
77.5±10.7 |
73.8±11.0 |
3.7±7.2 |
0.008 |
˂0.001 |
|
Food intake level |
84.7±12.7 |
67.8±13.4 |
17.2±10.8 |
˂0.001 |
˂0.001 |
|
Hand washing |
43.7±4.9 |
44.3±4.1 |
−0.4±3.2 |
0.339 |
0.126 |
|
Tooth brushing |
42.2±6.0 |
42.9±5.5 |
−0.5±4.2 |
0.375 |
0.202 |
|
Age |
|
≤4 yr |
|
HEPS |
247.5±23.3 |
226.0±22.8 |
21.4±18.3 |
˂0.001 |
˂0.001 |
|
Food preference |
77.4±10.0 |
73.1±9.7 |
4.3±7.6 |
˂0.001 |
˂0.001 |
|
Food intake level |
84.4±12.7 |
66.5±12.6 |
17.8±12.3 |
˂0.001 |
˂0.001 |
|
Hand washing |
44.0±5.1 |
44.1±4.1 |
−0.1±4.0 |
0.799 |
0.691 |
|
Tooth brushing |
41.9±6.3 |
42.4±6.0 |
−0.6±4.8 |
0.434 |
0.124 |
|
>4 yr |
|
HEPS |
250.5±22.2 |
226.3±28.8 |
24.6±18.0 |
˂0.001 |
˂0.001 |
|
Food preference |
80.0±9.5 |
74.1±10.9 |
6.1±7.3 |
˂0.001 |
˂0.001 |
|
Food intake level |
87.5±11.4 |
67.8±14.5 |
19.7±12.8 |
˂0.001 |
˂0.001 |
|
Hand washing |
42.3±5.7 |
42.6±5.1 |
−0.3±4.0 |
0.694 |
0.467 |
|
Tooth brushing |
40.8±6.2 |
41.8±5.5 |
−0.8±4.6 |
0.322 |
0.121 |
Table 4.Preschooler-parent score differences compared by sex and age
Table 4.
|
HEPS |
Sex |
P-valuea)
|
Age |
P-valueb)
|
|
Boy |
Girl |
≤4 yr |
>4 yr |
|
Total |
25.0±21.0 |
20.0±14.9 |
0.035 |
21.4±18.3 |
24.6±18.0 |
0.221 |
|
Food preference |
6.0±7.8 |
3.7±7.2 |
0.017 |
4.3±7.6 |
6.1±7.3 |
0.096 |
|
Food intake level |
19.7±13.9 |
17.2±10.8 |
0.120 |
17.8±12.3 |
19.7±12.8 |
0.283 |
|
Hand washing |
0.1±4.7 |
−0.4±3.2 |
0.313 |
−0.1±4.0 |
−0.3±4.0 |
0.693 |
|
Tooth brushing |
−0.8±5.3 |
−0.5±4.2 |
0.553 |
−0.6±4.8 |
−0.8±4.6 |
0.674 |
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